Physio leads therapy team in campaign which cut 4.45 unnecessary intermediate care bed days

Bolton NHS Trust’s intermediate care team has reduced patients’ average length of stay by 4.45 days since it introduced NHS Improvement’s Red2Green campaign in October 2017.


Bolton NHS Trust intermediate care team’s therapy lead Jennifer Sharples (second from left) with other members of the team

Physiotherapist Jennifer Sharples leads the multidisciplinary team that introduced Red2Green, a system to identify wasted time on a patient’s journey through hospital.

Red2Green aims to reduce the number of ‘red days’ which fail to contribute to a patient’s discharge, and increase the number of ‘green days’ when a patient receives interventions which support their care and discharge into the best setting for their needs.

Therapy team lead Ms Sharples said that Red2Green has had a positive impact on admissions too. Across three intermediate care units, the number of admissions have increased by an average of seven patients each month because of the earlier discharge of patients back home or to other care settings.

She said the programme had resulted in greater collaboration between the members of her team, which has six physiotherapists, plus occupational therapists and therapy assistants. It had also improved the team’s collaboration with other health professionals in intermediate care, including doctors, pharmacists and social workers.

Prioritising patients

Board rounds were held three times each week, but have been replaced with daily Red2Green meetings, where the progress of patients is reviewed each day.

‘Red2Green has not affected the amount, nor the quality of the therapy patients are getting,’ said Ms Sharples. ‘But it has affected the way our therapists prioritise patients.

‘It has helped the physiotherapists to make sure that the right patients are getting the right intensity of therapy and at the right time in their journey.

‘And it has helped the therapists to be able to say to the multidisciplinary team that a particular patient is ready for their care to be transferred into the community.

‘If the therapists are identifying earlier than a patient can be managed within a different environment, it means that other professionals, such as social workers, will get involved at an earlier point in the patient’s care too.’

Paired with other initiatives

Ms Sharples believes that Red2Green fits well with other initiatives to improve hospital care and quality of life. She identified the Last 1,000 Days initiative, about people living well during the last days of their lives, and EndPJparalysis, a campaign to get patients out of their pyjamas and up and out of bed.

The next stage for the programme will be to move the daily Red2Green meetings from 11.30am to the start of the day. Ms Sharples said this would give staff a longer period to carry out their care.

She also wants to introduce another NHS Improvement initiative, clinical criteria for discharge. This is designed to identify the minimum physiological, therapeutic and functional status the patient needs to achieve before discharge. Typically, this is used in acute care, but Ms Sharples thinks it could be adapted for intermediate care and be part of Red2Green.

Ahead of introducing Red2Green, Ms Sharples and colleagues spent a number of weeks educating staff about the changes. But she said the programme is now ‘completely embedded’ into the practice of the intermediate care team.

‘It’s consistent, staff know that it’s happening and they turn up every day and are really enthusiastic about Red2Green,’ she said.

‘They understand the benefits of doing this and we display our performance data so they can see that it’s having a positive impact on the service.’

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